Obesity Treatment: Diet and Physical Activity

Question 1

Weight bias exists and is prevalent among clinicians

Answer 1

• How do obese patients feel when they leave your office? Empowered or lectured?
• Have you done something positive?
• Many have had negative experiences with health professionals
• Almost every patient has tried at least once - may not have tried the right way or known what to do
• 1st step in treatment is complete history
• Best way to ask: Can we talk about your weight?
• Ask patients to write down what they eat

Question 2

Appropriate applications of diet, physical activity, behavioral changes in obesity treatment

Answer 2

• Calorie restriction diets = easiest way to create negative energy balance
  
  • Most important component of weight loss
• In long term: balanced diet is effective as any other for losing weight and maintaining weight loss
• Physical activity: important for preservation of fat free mass
  
  • Important for metabolism
  • Also improves appetite regulation, facilitates maintenance of weight loss, and increases overall health/decreases CV risk
• Physical activity alone: generally ineffective for weight loss - need to include calorie restriction

Question 3

Specific approaches to help obese patients change their diet: first steps

Answer 3

• Don’t drink calories: cut out sugar-sweetened drinks
• Increase servings of fruit & vegetables, especially vegetables
• Limit sweets to once per day
• Eat multiple small meals per day
• Reduce portion sizes of all foods by 25-33%
• Slow the pace of eating

Question 4

Specific approaches to help obese patients change their diet: more aggressive steps

Answer 4

• Purchase self-help diet book validated with scientific research and follow eating plan
• Use a structured meal plan (meal replacement approach)
• Join commercial weight loss program or university-based program
• Regular self-monitoring using dietary logs
  
  • Budget for calories and grams of fat

Question 5

Amount of physical activity recommended to maintain general health/prevent weight gain

Answer 5

• Vigorous activity: 30 minutes/day OR
• Moderate activity: 60 minutes/day

Question 6

Use of pedometers in weight loss

Answer 6

• Wear for one week to get baseline steps/day
• Set goal to increase steps by 500/day
  
  • 500 steps is approximately 5 minutes of brisk walking
• Work towards 10,000-12,000 steps/day to maintain weight loss long term
• If environment is difficult, may need a treadmill/bike/gym

Question 7

Examples of “lifestyle” physical activity

Answer 7

• Garden
• Play with kids
• Spend more time being active instead of sedentary

Question 8

Things that individuals in National Weight Control Registry do to maintain reduced weight (5)

Answer 8

1. Use of moderately low fat, high carb diets
2. Frequent self-monitoring
3. Eating breakfast
4. Large amounts of physical activity
5. Limiting TV viewing

Question 9

NWCR’s use of low fat/high carb diets: details

Answer 9

• Subjects report diet containing:
  
  • 24% fat
  • 19% protein
  • 55% carbohydrate
• Low fat diet important to keep weight off

Question 10

NWCR’s use of frequent self-monitoring: details

Answer 10

• Patients weigh themselves frequently
• Almost all weigh at least once/week
• Many weigh themselves daily

Question 11

NWCR’s use of eating breakfast: details

Answer 11

• 78% report eating breakfast 7 days/week
• 90% eat breakfast 4 or more days/week
• Only 4% report never eating breakfast

Question 12

NWCR’s use of large amounts of physical activity: details

Answer 12

• Participants engage in high levels of physical activity to maintain weight loss
• Average energy expediture due to physical activity ~2800 kcal/week
  
  • Corresponds to 1 hour/day of moderate intensity physical activity
• Average number of steps/day = 11,000
  
  • Contrast with sedentary person: average = 5,000/day
• Thought to keep metabolism high
• Thought to improve CV health
• Helps to preserve fat free mass

Question 13

NWCR’s use of limiting TV viewing: details

Answer 13

• Relatively minimal amount of time watching TV
• 63.5% watch < 10 hours/week
• 38.5% watch < 5 hours/week
• 12.5% watch > 21 hours/week

National average of American adults = 28 hours/week

Question 14

Differences between weight loss and weight loss maintenance

Answer 14

• Weight loss requires state of negative energy balance (intake < expenditure)
  
  • Mostly able to achieve through caloric restriction
• Negative energy balance can’t be maintained forever
  
  • Body adapts to caloric restriction –> lowers energy expenditure
• Most weight loss from diet and exercise occurs in first 3-6 months
• Weight loss maintenance: lifestyle that allows maintenance of energy balance (intake = expenditure)
  
  • Must be maintained indefinitely
  • Requires filling “energy gap” created by initial weight loss
    
    • Lower calorie intake
    • Greater physical activity
    • Combination of the two

Question 15

Challenges of weight loss maintenance

Answer 15

• Energy gap commonly in the range of several hundred calories/day
• 24 hour energy expenditure goes down more than would be predicted by weight loss alone
• Body tries to “defend” its higher weight
  
  • May account for high frequency of weight regain